Perspective Papers of the Global Forum on Innovation in Health Professional Education

Perspectives, published by the National Academy of Medicine (NAM), are individually authored by Roundtable and Forum members and outside experts in health and health care. The views expressed in these papers are those of the authors and not necessarily of the authors’ organizations or of the NAM. Perspectives are intended to help inform and stimulate discussion. They have not been subjected to the review procedures of and are not reports of the NAM or the National Academies of Sciences, Engineering, and Medicine.

Several members of the Global Forum have discussed topics of interest in further detail through National Academy of Medicine Perspectives. These perspectives, either in the form of discussion papers or commentaries, are available on the National Academy of Medicine website.

Perspective Papers on Stress and Wellness in Health Professional Education

Several members of the Global Forum are interested in illuminating issues concerning stress and burnout of health professionals and the role of health professional education to mitigate the negative effects of prolonged stress. An interprofessional group of individual Forum members came together to propose a systems-based approach to addressing stress that includes everyone across the health professions.

To develop a foundation for dialogue among the professions, individual members of the Global Forum from various health professions volunteered to write perspectives that summarize the types of stresses affecting their profession. These authors examine systems-level stressors from each of their individual perspectives, and explore how their profession responds to stress within education and practice. The hope is to gather input from health professionals, faculty, students, trainees, and administrators who experience unique stressors in order to add insight into a multifaceted systems approach to mitigating stress, and to identify potential interprofessional interventions that could improve the settings for everyone and create an environment in which all professionals can work together toward health and well-being for all.

The NAM Perspectives paper, Breaking the Culture of Silence on Physician Suicide, brought together four unique voices from surgery, nursing, medical training, and the clergy to consider what led Kaitlyn, a young medical student, to take her own life on April 11, 2013. Drawing from personal experiences, the authors exposed what they thought was a culture of silence under intense pressure that pushes physicians, health professionals, and trainees to experience depression and in some cases to

tragically end their lives. But these are just four opinions based on four experiences. The authors hope to bring more voices into the conversation by asking others who are comfortable doing so to share their own reactions to situations they have been forced to navigate throughout their education and careers as health care providers.

Dr. Arthur Hengerer, past chair of the Federation of State Medical Boards (FSMB), has taken up that charge. What follows is a powerful narrative, given the experience of the author and the personal commitment he is making to breaking—and rectifying—the culture of silence around burnout in our workforce.

TheNAM Perspectivespaper,Breaking the Culture of Silence on Physician Suicide, brought together four unique voices from surgery, nursing, medical training, and the clergy to consider what had led Kaitlyn, a young medical student, to take her own life on April 11, 2013. Drawing from personal experiences, the authors exposed what they thought was a culture of silence under intense pressure that pushes physicians and trainees to experience depression and in some cases to tragically end their lives. But these are just four opinions based on four experiences. The authors hope to bring more voices into the conversation byasking others who

are comfortable doing so to share their own reactions to situations they have been forced to navigate throughout their education and their careers as health care providers.

Dr. Jasleen Salwan, a primary care resident at the Yale New Haven Hospital,agreed to reprint her entry from the Yale Internal Medicine periodical, the Beeson Beat. The piece, titled “Breaking Silence, Breaking Stigma,” provides a strong step in normalizing vulnerability—and will ideally encourage other young physicians to share their experiences, solutions, and paths forward.

In this commentary, Dr. Miguel Paniagua, member of the Global Forum on Innovation in Health Professional Education, shares a personal reflection on the limits of physician resilience in response to the National Academy of Medicine Perspective,Breaking the Culture of Silence on Physician Suicide.

The National Academy of Medicine Perspective,Breaking the Culture of Silence on Physician Suicide, brought together four unique voices from surgery, nursing, medical training, and the clergy to consider what led Kaitlyn, a young medical student, to take her own life on April 11, 2013. Drawn from personal experiences, the authors expose what they feel is aculture of silence under intense pressure that pushes physicians and trainees to experience depression and in many cases to tragically end their lives. But these are just four opinions based on four

experiences. The authors hope to bring more voices into their conversation by requesting others who are comfortable with sharing to offer their own reactions to situations they were forced to navigate throughout their education and careers as health providers.

Dr. Elisabeth Poorman, a primary care doctor and a former resident at Cambridge Health Alliance, answered the call and agreed to reprint her entry in WBUR’s CommonHealth blog, published in August 2016. This piece is Dr. Poorman’s personal reflection on the rampant depression experienced by doctors and doctors in training.

Every year an estimated 400 U.S. physicians take their lives. Numerous global studies involving every medical and surgical specialty indicate that approximately 1 in 3 physiciansis experiencing burnout at any given time. Medical students appear to be at an equal or higher risk of burnout, depression, substance abuse, and suicide.Because of the perceived and real risks associated with seeking help for such problems, many students, trainees, and doctors, and health care organizations fail to recognize, report, discuss, or pursuetreatment for these conditions. The purpose of this paper is to shine a spotlight on this culture of

silence, to understand the scope and complexity of the underlying issues, and to drive changes to deliver individual, organizational, and societal interventions that preserve and promote the physical and emotional health of care givers.

accreditors from multiple health professions have joined together to discuss their role and to set continuing education standards for IPE and guidance for interprofessional foundational education. And although models for IPE exist to guide the learning process from education to practice, there are few guides for the historic work of accreditors to promote interprofessional collaboration across education and practice.

Accreditors occupy a unique position, working within and across professions and health care delivery settings to promote interprofessional collaboration in education and care. Those who work within individual health professions and those accreditors working in different health care delivery domains should look to cross professional and delivery divides for more integrated approaches to the evaluation and regulation of education and clinical practice.
Accreditors occupy a unique position, working within and across professions and health care delivery settings to promote interprofessional collaboration in education and care. Those who work within individual health professions and those accreditors working in different health care delivery domains should look to cross professional and delivery divides for more integrated approaches to the evaluation and regulation of education and clinical practice.

To further expand on these concepts, five individuals from the education, practice, and accreditation communities came together to propose a a new model, which focuses on the collaborative needs in education and care delivery and is the focus of this paper.

The Innovation Collaborative on Learning through Community Engagement (the IC) is a member-driven activity that aims to address research challenges to spreading and scaling-up innovations in community-engaged health professional education. Through a consultative and iterative process, Collaborative members developed a definition for “community-engaged health professional education.” Individuals authored this discussion paper describing the definition and its various elements.

In this commentary, Dr. Miguel Paniagua, member of the Global Forum on Innovation in Health Professional Education, shares a personal reflection on the limits of physician resilience in response to the National Academy of Medicine Perspective, Breaking the Culture of Silence on Physician Suicide.